California Licensed Utilization Management RN

Job Summary

A company is looking for an Inpatient Utilization Management RN to provide clinically efficient and effective inpatient utilization management remotely.

Key Responsibilities:

• Conducts clinical reviews for appropriate utilization of medical services based on medical necessity criteria
• Documents clinical reviews and decisions in the care management system accurately and timely
• Collaborates with the Medical Management team for care coordination and prepares clinical information for case reviews

Required Qualifications:

• Current unrestricted Registered Nurse (RN) license in state of residence
• 3+ years of clinical nursing experience in an acute care hospital or LTAC setting
• 1+ years of Utilization Management experience in a hospital or insurance setting
• Experience with Medicare and/or Medicaid guidelines, and Milliman (MCG) or InterQual guidelines
• Ability to work Monday-Friday 8am-5pm in Pacific Time Zone and participate in weekend and holiday rotation